E1000A: Wandering: Risk of Getting to Dangerous Place, Step-by-Step

Step-by-Step Coding Guide for Item Set E1000A: Wandering: Risk of Getting to Dangerous Place

1. Review of Medical Records

• Objective: Gather detailed information on the resident’s wandering behavior and associated risks.
• Steps:
  1. Collect Documentation: Obtain the resident's medical history, behavior logs, and previous assessments.
  2. Identify Relevant Information: Look for documented instances of wandering, notes on cognitive impairment, and any interventions in place.
  3. Review Incident Reports: Check for any reports of the resident attempting to enter or successfully entering dangerous areas.

2. Understanding Definitions

• Wandering: Moving about within a living environment with no discernible purpose, often due to cognitive impairment.
• Dangerous Place: Areas where the resident is at risk of harm, such as stairways, kitchens, exits, or areas with sharp objects or hazardous materials.

3. Coding Instructions

• Steps:
  1. Assess Wandering Behavior: Evaluate the resident's history and current risk of wandering into dangerous areas.
  2. Code Based on Findings:
     • 0: No, the resident does not wander or is not at risk of entering dangerous places.
     • 1: Yes, the resident wanders and is at risk of getting to dangerous places.

4. Coding Tips

• Detailed Observation: Ensure thorough observation and documentation of the resident's wandering patterns and any previous incidents.
• Consult Care Team: Collaborate with the interdisciplinary care team to gather insights on the resident's behavior and risks.
• Consider Environment: Evaluate the layout and potential hazards in the resident's environment that could contribute to the risk.

5. Documentation

• Required:
  • Assessment Notes: Detailed notes from the assessment, including specific instances of wandering and potential dangers identified.
  • Behavior Logs: Documentation of wandering episodes and interventions in place to mitigate risks.
  • Care Plan Updates: Reflect the assessment findings and any changes to the care plan to address wandering behavior.

6. Common Errors to Avoid

• Assuming No Risk: Do not assume the resident is not at risk without a thorough assessment, even if no incidents have been reported recently.
• Incomplete Documentation: Ensure all details from the assessment and observed wandering behavior are thoroughly documented.
• Ignoring Environmental Factors: Consider all environmental risks and ensure they are documented and addressed in the care plan.

7. Practical Application

• Example:
  • Resident Profile: Sarah, a resident with dementia, has been found wandering near the facility’s kitchen multiple times.
  • Steps:
    1. Review Records: The staff reviews Sarah’s records and notes multiple instances of wandering near the kitchen.
    2. Conduct Assessment: The staff member evaluates Sarah’s behavior, confirms the risk, and documents the assessment.
    3. Document and Code: The staff documents Sarah’s wandering behavior and codes item set E1000A as "1" (Yes).

Please note that the information provided in this guide for MDS 3.0 Item set E1000A was originally based on the CMS's RAI Version 3.0 Manual, October 2023 edition. Every effort will be made to update it to the most current version. The MDS 3.0 Manual is typically updated every October. If there are no changes to the Item Set, there will be no changes to this guide. This guidance is intended to assist healthcare professionals, particularly new nurses or MDS coordinators, in understanding and applying the correct coding procedures for this specific item within MDS 3.0. 

The guide is not a substitute for professional judgment or the facility’s policies. It is crucial to stay updated with any changes or updates in the MDS 3.0 manual or relevant CMS regulations. The guide does not cover all potential scenarios and should not be used as a sole resource for MDS 3.0 coding. 

Additionally, this guide refrains from handling personal patient data and does not provide medical or legal advice. Users are responsible for ensuring compliance with all applicable laws and regulations in their respective practices.